What Is the Evidence for Co-trimoxazole, Clindamycin, Doxycycline, and Minocycline in the Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA) Pneumonia?

Abstract

Objective: To review the evidence for trimethoprim-sulfamethoxazole (TMP-SMX), clindamycin, doxycycline, and minocycline in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. Data Source: MEDLINE, PubMed, EMBASE, Google, Google Scholar, Cochrane Central Register of Controlled Trials from 1946 to May 20, 2019. The search was performed with the keywords methicillin-resistant Staphylococcus aureus, MRSA, Staphylococcus aureus, pneumonia, trimethoprim, sulfamethoxazole drug combination, trimethoprim, sulfamethoxazole, TMP-SMX, co-trimoxazole, clindamycin, doxycycline, and minocycline. Data Extraction: Studies reporting the use of the above antibiotics for MRSA pneumonia treatment with clinical outcomes were included. Search parameters were limited to English language and human studies only. Data Synthesis: The search yielded 16 relevant articles: 6 TMP-SMX, 8 clindamycin, zero doxycycline, and 2 minocycline. For TMP-SMX, prospective randomized trials showed variable results; however, these studies were not specifically designed to assess MRSA pneumonia treatment. Retrospective studies with clindamycin suggested that it could be used as monotherapy or in combination with other anti-MRSA antibiotics. There was no evidence for doxycycline use, but 2 small retrospective reviews appeared to support minocycline as a treatment option. Relevance to Patient Care and Clinical Practice: These antibiotics are often used in clinical practice as potential treatment options for MRSA pneumonia. This article reviews the evidence for the clinical efficacy and safety of these agents. Conclusions: There are limited data to support use of TMP-SMX, clindamycin, doxycycline, or minocycline in MRSA pneumonia treatment. Randomized controlled trials are required to determine the effectiveness of these antibiotics. Clinicians should base their decision to use these agents on a case-by-case basis depending on clinical status and susceptibility results.

Lincosamide monotherapy treatment of methicillin-resistant Staphylococcus aureus pneumonia in tropical Australia: a case series

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providing the isolate is susceptible and bacteraemia has been excluded [6][7][8].In Far North Queensland, in tropical Australia, almost a third of all S. aureus isolates are methicillin-resistant [9]. Local clinicians routinely transition to lincosamide (lincomycin or clindamycin) monotherapy for patients with MRSA bacteraemia after confirmation of lincosamide susceptibility and exclusion of endocarditis, a strategy which has been shown to be safe and effective [10].

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Expanding treatment options for rosacea

“…We have learned from previous research that face-to-face education is effective in secondary prevention of HD in healthcare workers. 8 However, this is time-consuming and less cost-effective, but might still be a good option when focusing on those who are already affected by HD. In Germany, for example, participation in a skin protection seminar aiming to improve health-related behaviour has been an effective standard procedure in the management of individuals with work-related HD, including healthcare workers, for many years.…”

“…The choice of anti‐inflammatory medication is not straightforward, with a variety of topical and systemic agents available . One of the most commonly used oral antibiotics, doxycycline, can also be useful for serious infections such as methicillin‐resistant Staphylococcus aureus pneumonia, and antibiotic stewardship campaigns are trying to reduce unnecessary prescribing of oral antibiotics. Low‐dose isotretinoin can be an effective alternative but it is unlicensed for rosacea and clearly comes with certain issues .…”